Parents Want to Know About Every Pediatrician Error

(Hat tip: Schafer)

Parents Want to Know About Every Pediatrician Error
Same survey found they would be less likely to sue if told first.
By Amanda Gardner
ABC News

MONDAY, Dec. 5 (HealthDay News) — American parents want to know about medical errors involving their children, no matter how harmless or severe the mistake, new research suggests.

Parents also claim to be less likely to sue if they are told openly and honestly about an error, according to a study appearing in the December issue of Pediatrics.

"This is a very important study. Things aren't necessarily as well-studied in children as in adults, and our natural tendency is to assume that everything from adults applies to children, and that's not always true," said Dr. Marlene R. Miller, director of Quality and Safety Initiatives and an associate professor of pediatrics at Johns Hopkins Children's Center. "Among adults, we want more disclosure with more severe things. But parents of a small, vulnerable child want to know everything, regardless of the severity. That's a very key difference."

Medical errors have been a focus of attention lately, with a recent Institute of Medicine report estimating they are responsible for 100,000 deaths a year in the United States. According to the authors of this study, 42 percent of Americans say they have been affected by a medical error either personally or through a friend or relative.

Most of the information, however, applies to adults. Studies have shown that adults' desire to be informed of a medical error increases with the error's severity. It's been unclear whether parents felt the same way about errors affecting their children.

In this latest study, 499 parents of children presenting at a hospital emergency room answered a questionnaire outlining several different error scenarios. Participants were asked to rate the severity of the mistake, express preferences for disclosure and reporting, and to state how they expected to respond with or without that disclosure.

Virtually all (99 percent) of the parents wanted to be told of a mistake, while 39 percent wanted the error reported to a disciplinary body and 36 percent said they were less likely to pursue legal action if the error was disclosed by the doctor.

The finding that people were less likely to see legal recourse if the error was disclosed echoes previous studies in adults. "It's not so much the error that people get upset about —it's the anger at not being told," Miller said. "People can understand that medicine isn't black and white, that it's an art."

The desire to be told of a mistake did not differ by race/ethnicity, gender, age or insurance. However, the desire for an error to be reported to a disciplinary body increased with the severity of the error.

The challenge is how to integrate this information into the medical system. "We rarely teach how to disclose," Miller said. "Any time you advocate a big change in behavior or practice, you probably need some training, what is appropriate, how do we do it, when do we do it. It's not as simple as it sounds."

A second study in the same issue of the journal found that using a preprinted, structured order form for medications significantly reduced medication errors among children in the emergency department.

The study authors had previously found that 10 percent of children who went to a pediatric emergency department experienced medication errors.

On different days, physicians were asked to use either regular, blank order sheets for prescriptions or the preprinted, formatted sheets. Drug errors were identified in 17 percent of the regular forms, and only 10 percent of the preprinted forms.

"This is a breath of air that, if you're an institution that can't afford computerized order entry, there are some very simple pen-and-paper solutions. If you have the right culture around the pen and paper, it's easy to do," Miller said.

A third study in the journal found that expensive computerized systems are not always the panacea they are held up to be, Miller pointed out. In fact, it found an increase in mortality after a computer order entry system was installed. Among 1,942 children admitted to a hospital for specialized care during the study period, the mortality rate went from 2.8 percent before the computer system was installed to 6.57 percent after the system was up and running.

The preprinted order forms, however, only addressed the prescribing phase of giving a medication, not the dispensing phase or administration phase. "The bulk of errors actually occur at administration, but it's a nice breath of air because some pen-and-paper, simple things that cost a couple of cents can work," Miller said.

Visit the National Patient Safety Foundation for more on medical mistakes.